Legislature(2017 - 2018)BELTZ 105 (TSBldg)

02/22/2018 01:30 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SB 165 Out of Committee
-- Public Testimony --
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                SB 161-DENTISTRY: TEMPORARY PERMIT                                                                          
1:50:48 PM                                                                                                                    
CHAIR  COSTELLO   reconvened  the   meeting  and   announced  the                                                               
consideration of SB 161.                                                                                                        
1:51:18 PM                                                                                                                    
SENATOR DAVID  WILSON, Alaska State Legislature,  Juneau, Alaska,                                                               
introduced  SB 161  on behalf  of  the Senate  Health and  Social                                                               
Services Committee. He and Senator  von Imhof both worked on this                                                               
committee  bill. It  is  "An  Act relating  to  the licensure  of                                                               
dentists.  It would allow the  Board of Dental Examiners to grant                                                               
a temporary license when a  dentist is suddenly incapacitated and                                                               
needs an immediate replacement. When  an Alaska dentist is unable                                                               
to work, it  creates an immediate gap in care  for Alaskans. Many                                                               
other  health care  professionals have  a mechanism  in place  to                                                               
issue  temporary licenses  and SB  161  would allow  one for  the                                                               
dental profession.                                                                                                              
1:52:24 PM                                                                                                                    
JASMIN  MARTIN,   Staff,  Senator  David  Wilson,   Alaska  State                                                               
Legislature,  Juneau, Alaska,  stated that  Senate Bill  161, "An                                                               
Act  relating to  the  licensure of  dentists,"  would allow  the                                                               
Board of  Dental Examiners to  issue a temporary license  when an                                                               
incapacitated  dentist  needs  a   replacement  for  an  extended                                                               
period. She  said there are  so few dental specialists  in Alaska                                                               
that just one  incapacitation can leave a large gap  in care. She                                                               
referenced a  document that lists the  various dental specialties                                                               
and  noted that  Anchorage is  the only  community where  all the                                                               
specialties are represented.  Several specialties are represented                                                               
in  Fairbanks,  Juneau, and  the  MatSu  area but  the  remaining                                                               
communities in  the state are  either not  served or served  by a                                                               
traveling dental specialist.  Small communities have historically                                                               
had  difficulty  recruiting  health care  practitioners.  SB  161                                                               
provides a quick solution through a temporary permit.                                                                           
1:53:49 PM                                                                                                                    
She provided the following sectional analysis for SB 161:                                                                       
     Section 1 amends Sec. 08.36.100, which is the section                                                                      
     addressing examination and licensing for dentistry.                                                                        
     Section  2  adds  a  new section  to  article  2,  Sec.                                                                    
     08.36.254.  Temporary  permit   to  substitute  for  an                                                                    
     incapacitated dentist. It  details the requirements and                                                                    
     process for obtaining this new dental permit.                                                                              
MS.  MARTIN  reviewed  the  fiscal  note  for  SB  161  from  the                                                               
Department  of  Commerce,  Community  and  Economic  Development.                                                               
Should the bill pass, the  Division of Corporations, Business and                                                               
Professional Licensing  will need $2,600  in FY19 to  cover legal                                                               
costs  to amend  regulations,  printing, and  postage. The  total                                                               
revenue  collected  from  the licensing  fee  will  approximately                                                               
equal the costs.                                                                                                                
She noted  the letters of  support in  the bill packets  from the                                                               
Alaska  Dental  Society and  the  Alaska  State Board  of  Dental                                                               
1:54:58 PM                                                                                                                    
At ease                                                                                                                         
1:57:42 PM                                                                                                                    
CHAIR COSTELLO  reconvened the meeting  and advised  that members                                                               
had  received the  document that  shows the  breakdown of  dental                                                               
specialists in Alaska.                                                                                                          
1:58:09 PM                                                                                                                    
SENATOR GARDNER  asked if the proposed  temporary license holders                                                               
would have met all the requirements to be a licensed dentist.                                                                   
SENATOR WILSON deferred  the question to dental  experts who were                                                               
available online to answer questions.                                                                                           
1:58:56 PM                                                                                                                    
SENATOR  MEYER asked  if dentists  who hold  a temporary  license                                                               
would become  part of a pool  that can be called  upon to replace                                                               
an incapacitated dentist.                                                                                                       
SENATOR WILSON  directed attention  to paragraph  (f) on  page 2.                                                               
That  language specifies  that a  temporary  permit is  initially                                                               
valid  for 90  consecutive calendar  days. Permit  extensions are                                                               
allowed  but for  not  more  than 240  calendar  days during  any                                                               
consecutive 24  months. The idea was  not to have a  locum tenens                                                               
dentist who  travels to and  from Alaska.  It is for  a temporary                                                               
substitution in an emergent situation.                                                                                          
SENATOR MEYER asked if there is  a pool of temporary licensees to                                                               
choose from.                                                                                                                    
SENATOR WILSON said not necessarily.                                                                                            
SENATOR GARDNER directed attention  to subsection (c) starting on                                                               
page 1, line 15. She noted  that language is contrary to previous                                                               
testimony  that  suggested  that  there are  dentists  who  treat                                                               
patients in a cluster of  villages. Subsection (c) specifies that                                                               
the  temporary permit  is only  valid to  treat patients  "at the                                                               
address  listed  on the  business  license  of the  incapacitated                                                               
2:02:00 PM                                                                                                                    
MS. MARTIN deferred to the experts online.                                                                                      
SENATOR GARDNER directed attention  to subsection (g) starting on                                                               
page 2, line 17.  It says the permit can only  be extended if the                                                               
board  determines it  is necessary  to  provide essential  dental                                                               
services  and has  received clearance  reports from  the National                                                               
Practitioner   Data   Bank   and  the   U.S.   Drug   Enforcement                                                               
Administration.  She  asked  why   those  two  clearance  reports                                                               
wouldn't  be  advisable  for  the original  permit  if  they  are                                                               
required for the extension.                                                                                                     
SENATOR WILSON said the idea is  to have more due diligence for a                                                               
more permanent situation.                                                                                                       
2:03:50 PM                                                                                                                    
SENATOR  STEVENS  questioned  why   someone  would  apply  for  a                                                               
temporary license when they could get a permanent license.                                                                      
MS. MARTIN replied a temporary  permit is appropriate for someone                                                               
who doesn't plan  to practice dentistry in  Alaska permanently or                                                               
is recently retired and willing to temporarily fill the gap.                                                                    
SENATOR  STEVENS asked  if  the process  of  getting a  permanent                                                               
license is much more onerous and lengthy.                                                                                       
MS. MARTIN deferred the question to the dentistry board.                                                                        
SENATOR  MICCICHE  offered  his understanding  that  someone  who                                                               
applies  for  a  temporary  permit  could  have  previously  been                                                               
licensed under  AS 08.36.110 but has  chosen not to keep  up with                                                               
the requirements  under AS 08.36.234.  The individual would  be a                                                               
qualified  dentist   who  is  not  continuing   their  competency                                                               
MS. MARTIN agreed.                                                                                                              
SENATOR MICCICHE  pointed out that  the initial  90-day temporary                                                               
permit and three  60-day extensions do not add up  to the 240-day                                                               
maximum. He requested an explanation.                                                                                           
CHAIR COSTELLO  suggested the sponsor  follow up with  the answer                                                               
since the bill wasn't moving today.                                                                                             
She observed  that the  members' questions  are focused  on where                                                               
the pool  of people is coming  from. She asked if  these could be                                                               
people licensed  in other states  or Alaskan dentists  who aren't                                                               
SENATOR WILSON said it could be either or both scenarios.                                                                       
CHAIR COSTELLO asked him to  talk about the public safety aspect;                                                               
she assumed  that the clearance  reports referenced on page  2 in                                                               
subsection  (g),   paragraphs  (1)   and  (2)  would   include  a                                                               
background check.                                                                                                               
SENATOR  WILSON  explained  that  the  Board  of  Dentistry  will                                                               
thoroughly  vet   and  select  the  qualified   applicants.  This                                                               
includes an  extensive background  check and  fingerprinting that                                                               
goes through the FBI system.                                                                                                    
CHAIR  COSTELLO  asked  if  the bill  covers  liability  and  the                                                               
client's right to file suit. She  also asked if other states have                                                               
successfully implemented temporary dental licenses.                                                                             
SENATOR  WILSON said  his office  has not  looked at  other state                                                               
laws  regarding dentistry.  He offered  to do  some research  and                                                               
follow up with the information.                                                                                                 
SENATOR  STEVENS  offered  his  understanding  that  a  temporary                                                               
permit only  relates someone who  has been licensed in  the past.                                                               
He asked  if that  excludes a recent  dental school  graduate who                                                               
has never applied for and held a permanent license.                                                                             
SENATOR WILSON replied it would  not exclude a recent graduate if                                                               
they have the qualifications.                                                                                                   
SENATOR STEVENS  observed that previous  testimony that  it would                                                               
need  to be  someone who  was licensed  in the  past isn't  quite                                                               
SENATOR WILSON said he would follow up with clarification.                                                                      
CHAIR  COSTELLO said  the committee  will wait  for an  answer to                                                               
that question too.                                                                                                              
She asked if  the board meets often enough or  has a provision to                                                               
meet to  accommodate these emergency  situations. She  also asked                                                               
if the  temporary license must  be displayed and if  the licensee                                                               
is obligated  to inform the  patient that he/she has  a temporary                                                               
SENATOR WILSON  replied that could be  added to the bill  if that                                                               
is the will of the committee.                                                                                                   
2:13:52 PM                                                                                                                    
CHAIR COSTELLO opened public testimony on SB 161.                                                                               
2:14:20 PM                                                                                                                    
DAVID  NIELSON, Member,  Board  of  Dental Examiners,  Anchorage,                                                               
Alaska, stated  that the dental  board recently noticed  that the                                                               
governing statutes  lacked a permitting option  that is available                                                               
to  other  professional licensing  boards  in  Alaska. The  board                                                               
approached the dental society to  help with the issue that arises                                                               
in the  rare instance  that a  dentist becomes  incapacitated and                                                               
their patient  base can't  be absorbed  by licensed  dentists who                                                               
are practicing  in the state.  Creating a temporary  permit would                                                               
allow the  board to address  this issue without waiting  the four                                                               
to  six months  it  generally takes  to  collect the  information                                                               
required for  an applicant  to become  credentialed and  issued a                                                               
He mentioned the requirements under  AS 08.36.234 and stated that                                                               
the board is  willing to develop regulations that  would apply to                                                               
the new permit.  He recalled an earlier  question about liability                                                               
and opined that  there would be a requirement  that the applicant                                                               
have  a license  in good  standing in  some other  U.S. state  or                                                               
territory. He surmised  that they would also be  in good standing                                                               
with the National Practitioner Data Bank.                                                                                       
CHAIR  COSTELLO  asked  him  to   comment  on  Senator  Gardner's                                                               
question about  the temporary permit  only being valid  "to treat                                                               
patients of  the incapacitated dentist  at the address  listed on                                                               
the  business  license  of the  incapacitated  dentist."  Senator                                                               
Gardner  asked if  this would  make it  more challenging  for the                                                               
temporary licensee to treat people in a region.                                                                                 
DR. NIELSON said that was  generally meant to mean that practices                                                               
could occur in satellite offices                                                                                                
CHAIR  COSTELLO asked  if  he  had the  document  that shows  the                                                               
different dental specialties represented in Alaska.                                                                             
DR.  NIELSON  said  no  but  he is  aware  that  specialists  are                                                               
concentrated in larger communities.                                                                                             
2:19:37 PM                                                                                                                    
SENATOR GARDNER  asked for clarification that  the people getting                                                               
a  temporary  permit  would  all  be  licensed  practitioners  of                                                               
DR.  NIELSON said  yes. He  added  that the  board would  develop                                                               
regulations, but  he didn't  imagine that  a recent  graduate who                                                               
had  not been  licensed  in  any U.S.  state  or territory  would                                                               
qualify for this permit.                                                                                                        
SENATOR GARDNER  asked if  the applicants would  need to  hold an                                                               
active license to practice dentistry.                                                                                           
DR. NIELSON declined to speak to  that and noted that a committee                                                               
substitute  was  anticipated. He  pointed  out  that the  current                                                               
draft says  it must be a  position that is not  reasonably filled                                                               
by current licensees.                                                                                                           
SENATOR  GARDNER suggested  the forthcoming  committee substitute                                                               
should  include language  about an  active license  and liability                                                               
insurance. She  also expressed interest  in knowing  how Alaska's                                                               
license requirements for dentists compare  to other states and if                                                               
there is a national standard.                                                                                                   
2:22:44 PM                                                                                                                    
SENATOR  MICCICHE  pointed out  that  the  bill only  waives  the                                                               
continued  competency   requirements  under  AS   08.36.234.  The                                                               
temporary   permit  holder   would   still  need   to  meet   the                                                               
requirements under AS 08.36.110,  which is the qualifications for                                                               
license. He described some areas  of the legislation as  a little                                                               
MR. NIELSON  said there  is a committee  substitute in  the other                                                               
body and he  assumes one is forthcoming in the  Senate. He wanted                                                               
it  clear that  the dental  board supports  a permit  category of                                                               
this type.                                                                                                                      
2:24:05 PM                                                                                                                    
SENATOR STEVENS asked  how long a license remains  in effect when                                                               
a dentist retires.                                                                                                              
MR. NIELSON replied  the license is valid as long  as the dentist                                                               
pays  the  annual  renewal  fees and  keeps  up  with  continuing                                                               
SENATOR  STEVENS said  he suspects  that retiring  dentists would                                                               
maintain their licenses  in good standing much the  same way that                                                               
teachers do.                                                                                                                    
MR. NIELSON agreed that most  people keep their license active as                                                               
long as they feel they can contribute.                                                                                          
CHAIR COSTELLO  directed attention  to the language  in paragraph                                                               
(e) on  page 2. She  observed that it will  be a burden  to reach                                                               
out to  find out if  somebody "may reasonably substitute  for the                                                               
incapacitated dentist.  She  asked the meaning of  the phrase may                                                               
reasonably substitute.                                                                                                          
MR. NIELSON replied  it probably means that if  a general dentist                                                               
in Anchorage  becomes incapacitated,  it is reasonable  to expect                                                               
another Anchorage dentist could help.                                                                                           
2:28:32 PM                                                                                                                    
DR. JULIE  ROBINSON, Delegate, Alaska Dental  Society, Anchorage,                                                               
Alaska, stated that  the dental society recently  became aware of                                                               
rare  situations where  an Alaska  dentist becomes  incapacitated                                                               
and their  patient base  is uncovered  for geographic  reasons or                                                               
because the  dentist is a  specialist and no licensed  dentist is                                                               
willing or able  to cover. The Alaska Dental  Society supports SB
161  which  gives the  Board  of  Dental Examiners  an  expedited                                                               
process to grant a temporary permit in such cases.                                                                              
SENATOR  STEVENS asked  if  the  bill would  allow  the board  to                                                               
decide  to  substitute  a  dentist   who  practices  outside  the                                                               
specialty field of the incapacitated dentist.                                                                                   
DR. ROBINSON  offered her understanding  that nobody  outside the                                                               
specialty   field  would   be  approved   to  substitute   for  a                                                               
specialist. Finding a substitute for  a specialist is the primary                                                               
concern, she  said. If  a specialist who  travels to  rural areas                                                               
becomes  incapacitated, the  specialists in  those larger  cities                                                               
may not  be able to  leave their practices, whereas  a specialist                                                               
from out of state may be able to do that for a limited period.                                                                  
SENATOR MICCICHE asked  for clarification that the  bill does not                                                               
affect a dentist who is licensed  in Alaska. They can step in and                                                               
substitute for another dentist.                                                                                                 
DR.  ROBINSON said  that  is  correct. It's  not  uncommon for  a                                                               
general  dentist in  a larger  city to  fill in  on a  short-term                                                               
basis. It's a different matter  if the incapacitated dentist is a                                                               
specialist who travels to rural communities                                                                                     
SENATOR  MICCICHE   offered  his  understanding   that  currently                                                               
unlicensed  dentists that  have previously  been licensed  may be                                                               
temporarily  permitted   to  practice   through  the   waiver  of                                                               
continued competency requirements.                                                                                              
DR. ROBINSON said  no; the person must have an  active license in                                                               
[Alaska  or] another  state and  thus have  continued competency.                                                               
The bill  just waives the fact  that the person does  not have an                                                               
Alaska license.                                                                                                                 
2:32:42 PM                                                                                                                    
CHAIR COSTELLO found no one else who wished to testify and                                                                      
closed public testimony on SB 161.                                                                                              
She held SB 161 in committee awaiting answers to several                                                                        

Document Name Date/Time Subjects
SB 165.PDF SL&C 2/22/2018 1:30:00 PM
SB 165
SB165 Sponsor Statement.pdf SL&C 2/22/2018 1:30:00 PM
SB 165
SB165 Sectional Analysis.pdf SL&C 2/22/2018 1:30:00 PM
SB 165
SB 165 CMS Letter Approving Alaska's State Innovation Waiver.pdf SL&C 2/22/2018 1:30:00 PM
SB 165
SB165-DOA-DOF-02-15-18.pdf SL&C 2/22/2018 1:30:00 PM
SB 165
SB165-DCCED-DOI-02-16-18.pdf SL&C 2/22/2018 1:30:00 PM
SB 165
SB 161.PDF SL&C 2/22/2018 1:30:00 PM
SB 161
SB 161 - Sponsor Statment.pdf SL&C 2/22/2018 1:30:00 PM
SB 161
SB 161 Legal Memo Exemptions 01-22-18.pdf SL&C 2/22/2018 1:30:00 PM
SB 161
SB 161 Legal Memo Temporary Permits, Exemptions 01-26-18.pdf SL&C 2/22/2018 1:30:00 PM
SB 161
SB 161 - Letter of Support - Alaska Dental Society.pdf SL&C 2/22/2018 1:30:00 PM
SB 161
SB 161 - Letter of Support - Alaska State Board of Dental Examiners President.pdf SL&C 2/22/2018 1:30:00 PM
SB 161
SB161-DCCED-CBPL-02-16-18.pdf SL&C 2/22/2018 1:30:00 PM
SB 161